Perfil clínico e epidemiológico de pacientes pediátricos portadores de febre reumática atendidos em um Centro de Especialidades Médicas do Pará

Abstract

Introduction: Rheumatic fever consists of a non-suppurative inflammatory process resulting from an immune response to pharyngotonsillitis caused by beta-hemolytic A streptococcus and affects mainly developing countries. Arthritis is the most common clinical manifestation, followed by carditis, which is the manifestation of the worst prognosis, fever is a common symptom at the beginning of the acute condition. The diagnosis is based on the Jones criteria, requiring the presence of two major criteria or one major and two minor criteria. The main way to avoid its complications is through prophylaxis with benzathine penicillin G lasting for years, varying according to the degree of involvement. Objective: To analyze the clinical and epidemiological profile of pediatric patients with rheumatic fever in a Center of Medical Specialties in Pará. Method: An observational, cross-sectional, descriptive study was carried out, with a quantitative assessment of 17 medical records of patients with rheumatic fever at the Pediatric Rheumatology outpatient clinic from January 2017 to October 2020. Results: Patients with rheumatic fever correspond to 5.10% of the total number of patients attended at the Pediatric Rheumatology outpatient clinic. Of the total, 10 patients were male and 7 female. In addition, 10 were 10 years old or older. As for socioeconomic conditions, 70.6% lived in a brick house, and this same percentage lived in an urban area and 47.1% had a family income equal to or less than 1 minimum wage. No patient reported similar cases in the family. As for clinical manifestations, fever was found in 88.2% of cases, arthritis in 58.8%, mild carditis in 47.1%, Syndeham's chorea in 35.3%, erythema marginatum in 35.3%, migratory arthralgia in 29.4% and subcutaneous nodules in 29.4%. Also, 58.8% arrived at the clinic with the diagnosis. The most frequent reasons for referral were rheumatic fever (7), carditis (5) and Syndeham's chorea (5). The most requested initial exams were blood count (13), ESR (13), PCR (13) and ASLO (12). After starting follow-up at the outpatient clinic, 100% of the patients received treatment with benzathine penicillin G. Conclusion: In this research, mainly male, brown patients, from the countryside and with an average age of 10 years, were affected. The most common clinical manifestations were fever, carditis and arthritis. The most requested initial tests were blood count, ESR, CRP and ASLO and the median time between the first manifestation and the diagnosis was 2 months. Five patients interrupted prophylaxis with benzathine penicillin G and two patients presented recurrence.